Older people’s perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study

Abstract Objective: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. Method: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. Results: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. Conclusion: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population’s needs.


Introduction
Increased longevity is part of the demographic transition in most countries and Brazil is no exception.
The aging process draws attention to the health conditions of older people because this phenomenon is accompanied by a higher risk of disability and morbidities (1) . As people age, some physiological, psychological and social changes occur (2)(3) . These changes can lead to a variety of syndromes and issues, which, in turn, can lead to poor health outcomes (4) . For instance, critical illnesses and chronic diseases carry substantial risk of decreased functional capacity for older people (5) . In addition, functional inability can worsen already poor health outcomes.
Functional capacity is a relevant indicator of health status in older people and it is closely related to quality of life (6) . Functional capacity and inability are seen in terms of maintenance of autonomy, which for older people can be conceptualized as the ability to perform self-care, self-maintenance and physical activity (7) . Thus, mobility challenges may indicate functional decline and is a relevant problem for many older people.
Simply defined as the ability to move safely from one place to another, mobility is fundamental for engaging in daily activities (8) and allowing older people to lead independent lives. A well-known framework described five interrelated components of mobility: physical, cognitive, psychosocial, environmental, and financial domains (9) .
In this framework, mobility is "the ability to move within community environments that expand from one's own home, to the neighborhood, and to regions beyond". We draw from a similar framework to underpin this study, the International Classification of Functioning, Disability and Health (10) , which states that mobility influences and is influenced by determinants within different dimensions, such as health conditions, body functions and structures, participation, and contextual factors (i.e., environmental and personal factors). Both frameworks capture indoor and outdoor movement as well as the use of assistive devices and transportation (9)(10) . However, the International Classification of Functioning, Disability and Health (10) framework emphasizes participation in activities as a pivotal dimension, for it plays a major role in mobility.
In addition, the International Classification of Functioning, Disability and Health (10) framework supports contextual factors as strong determinants, either as facilitators or barriers, of functional outcomes. These include external environmental factors such as community, socioeconomic status and access to health care, as well as personal factors such as demographic characteristics, culture and upbringing, lifestyle preferences, motivation and personality traits.
The prevalence of mobility challenges among older people in Brazil is high. According to researchers' findings, mobility challenges affect 15% and 24% of people aged 60 and over and 70 years old and over, respectively (11) .

This is corroborated by a survey conducted in 2013 in
Brazil measuring mobility through a hierarchical approach using activities of daily living (12) . With regard to performing basic and instrumental activities of daily living, 30.1% of the Brazilian older people (60 years old or over) reported having difficulty. In addition, prevalence tends to surge with age -16.4% among the older people aged [60][61][62][63][64] years old reported facing challenges to perform activities of daily living, when compared to 48.3% among those aged 75 and over (12) .
In terms of global guidelines, mobility has been highlighted as a goal for healthy aging -the process of developing and maintaining the functional capacity that allows well-being in older age (13) . For instance, the United Nations Decade of Healthy Ageing (2021-2030) (13) and the Sustainable Development Goals (14) bring together governments, civil society, international agencies, professionals, academia, the media, and the private sector to improve the lives of older people, their families, and the communities in which they live to promote older people's mobility, which is paramount to functional capacity (15) .
In practice, a wide range of interventions have been developed to promote mobility. Special attention is given to interventions founded on the principle that some critical predictors of mobility decline are modifiable (16) .
Therefore, physical activity emerges as a possible intervention to improve or maintain mobility in older people by remodeling critical determinants (17)(18) . There is evidence that mobility-challenged older people benefit from interventions targeting muscular strength, flexibility and balance (19) , such as the Sit-to-stand activity.
The Sit-to-stand motion is a transition movement and one of the most frequently performed by humans (20) .
Rising from a sitting to a standing position is considered a prerequisite to walking and other functional activities. The Sit-to-stand activity is a simple action involving the act of repeatedly sitting down and standing up from a chair, and is frequently completed in the context of daily life.
Given the relevance of the ability to rise from a seated to a standing position and vice-versa, the Sit-to-stand activity emerges as a likely intervention to effectively improve or maintain mobility in older people. This is corroborated by studies from countries in the Global North suggesting that repeated Sit-to-stand activity can maintain or improve mobility in older people (21) .

While some of the benefits and advantages of the
Sit-to-stand intervention have been well documented, most of this research has been conducted in countries from the Global North. This makes identification of Wisnesky UD, Olson J, Paul P, Dahlke S. the impact of modifiable determinants (barriers and enablers) for engaging in the Sit-to-stand activity not clear for people from the Global South, which, in turn, makes it more difficult to implement those interventions in these settings (22)(23)(24) . Therefore, appropriate and effective interventions to improve mobility are not reaching many of those in need. Rarely does knowledge translation of interventions prioritize the individuals, nations or communities who most need the knowledge, which maintains gaps in health literacy and inequalities between the researchers and the researched (25) . Within the production of knowledge systems, research without practical relevance or application has no merit or value.
Our study contributes to the relevance of taking into consideration the contextual factors during the knowledge translation process.
All things considered, it is not enough to solely transfer successful interventions from one country or setting to another. Before conducting an intervention study, it is important to first examine the context wherein the intervention would be introduced (24) . Particularly for Brazilian community-dwelling older people living with mobility challenges, mobility involves cultural elements; it is an integral part of their sense of self and is strongly related to contextual factors (26) . In line with a knowledge translation standpoint, this pre-feasibility research is the first step to link the Sit-to-stand activity, a successful intervention from the Global North, and culturally relevant knowledge produced during the research to what Brazilian older people know about mobility and physical activity.
The objective of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes.

Study design
Many factors can affect the successful implementation and validity of an intervention. Therefore, the primary purpose of employing a pre-feasibility (and feasibility) approach is to assess the prospects for successful implementation of a potential intervention and to reduce threats to the validity of these interventions. Focused ethnography was the qualitative approach selected to examine urban Brazilian community-dwelling older peoples experiences of a Sit-to-stand activity (27) . Constructivism was the assumption underpinning this study, which adhered to the Consolidated Criteria on Reporting Qualitative Research -COREQ (28) .

Setting and participants
The Family Health Strategy unit at a healthcare center located in Paquetá, an island in Rio de Janeiro, Brazil, was selected as the study setting. In Brazil, a Family Health Strategy unit delivers primary health care through the public health system. It has multidisciplinary teams, including community health workers, which are responsible for meeting the heath care needs of approximately 1,000 households in a defined geographical area.
After access was granted at the Family Health Strategy unit and potential participants were identified, healthcare providers from the health center acted as gatekeepers and asked the participants if they agreed to put their contact details on a list so that they could be approached to take part in a health research study. The potential participants were contacted by the first author (who was a nurse with a master's degree in both social sciences and history and was a PhD candidate in nursing at the time of the research) to receive more details about the study, as well as to discuss reasons for doing the research.
Purposive sampling was employed to select the participants (29) . Our anticipated final sample size was 20 participants, as this was consistent with the mean sample sizes of two studies of exercise/physical activity with an older population using focused ethnography (30)(31) . Sampling was only discontinued when we achieved informational redundancy (32) .
Older people were included in the study if they: (1) had a self-reported mobility challenge such as difficulty with mobility when performing any basic or instrumental activities of daily living, or were unable to engage in social activities; (2) lived in the community; (3) were ≥ 60 years of age; (4) were able to understand and communicate in Portuguese; (5) were able to provide their written informed consent in Portuguese; and (6) did not present any pre-existing diagnosis of cognitive challenge and were considered by their healthcare providers as having sound cognitive competence, which was based on their health history and on the care provider's judgment. The exclusion criteria for older people were as follows: (1)

Questions
Can you tell me using as many details as possible about the Sit-to-stand activity you have performed during the last 4 weeks?
Did you talk to any community members about positive or negative effects of the activity? If yes, can you share with me some of the content of your discussions?
How do you feel in relation to your mobility after finishing the activity?
Do you intend to keep doing the activity after the study ends?
Do you have any comments on the content and design of the Sit-to-stand activity? Anything we could do better? Anything that would encourage you to do it?
These are all my questions for this interview. Would you like to add anything, or say something that you think is important but it was not discussed, before we end this interview? observations, informal interviews, formal semi-structured interviews, and field notes. The first author performed the observations and interviews. After the participants gave their verbal consent to participate in the study, six home visits were planned with each of them. In the first home visit, the study information was reviewed with the participants and their written informed consent was obtained. Subsequently, the researcher asked them to answer the socio-demographic survey. At the end of the first visit, the researcher taught the Sit-to-stand activity to the participants.
From the second to the fifth home visit, the researcher perform participant observations and informal interviews as activities to generate data. Once a week and for four weeks, the researcher observed how the participants performed the Sit-to-stand activity and conducted informal interviews on topics regarding their experiences and perceptions in relation to the Sit-to-stand activity. We pre-established this 4-week timeframe to perform participant observations and informal interviews because we believed that a careful sampling strategy and detailed field notes, combined with the researcher's reflexive approach, would be sufficient to observe both the participants' mobility patterns and their Sit-tostand performance. Nonetheless, the data generation activities were only to be discontinued when informational redundancy was achieved.
As for the informal ethnographic interview, " [it] occurs whenever the researcher asks someone a question during the course of participant observation" (33) . The focus of these informal interviews was to allow the researcher to engage with the participants while they went about their daily activities and convey information in culturally patterned ways. During these informal interviews, the researcher mainly asked questions to expand on her field observations. Finally, the sixth and last visit was devoted to the formal interview focused on the research question: How do Brazilian older people living with mobility challenges experience the Sit-to-stand activity? The last visit was also devoted to the "getting out" or disengagement phase, where the researcher went over the study pre-established goals and accomplishments (e.g., objectives, timelines).
This phase ended with an offer to send a report of the research findings to the participants, upon completion (34) .
None of the authors were known to the participants before the study. The data were generated between June and

The interviewer facilitated all discussions in
Portuguese, which is the language spoken by the participants and her own mother tongue. At times, upon the participants' request, their family members were present during data generation; however, these family members did not answer for the participants and were not included in the research process. The interviews were audio-recorded and field notes were made after the observations and informal interviews.
When necessary, these notes were used to clarify any inaudible recordings, to consider the Sit-to-stand activity patterns performed by the participants, and to better promote reflection during data analysis. The passive to moderate observation (33) sessions lasted a mean of 15-20 minutes per participant and were performed during the six encounters, totaling a mean of 33 observation hours.
Each formal semi-structured interview lasted from 30 minutes to one hour. In order to establish and maintain responsible "data stewardship" practices, all components of the ethnographic record were digitalized and encrypted.
The data were stored, managed, accessed and analyzed within a secured SharePoint environment.
Member checking was performed simultaneously during each interview when the interviewer summarized what was said and asked the participants whether their understanding was realistic, fair and representative in order to minimize distortion of findings. Member checking was then employed as a reflexive mode of knowledge production (35) . It ensured agreement in the representation, as the participants had the opportunity to discuss and negotiate the meanings during the interviews.

Data analysis
All the audio-recordings from interviews were transcribed by the first author. Data analysis was an iterative process performed simultaneously with data generation. Data translation was performed (Portuguese and English) because the study participants and some of the researchers spoke different languages. The data translation procedures are described elsewhere (26) .
The transcripts were imported to the NVivo 11 data management software (QSR International Pty Ltd, Victoria, Australia). A qualitative content analysis was inductively performed and key themes were generated. The steps that followed were (1) coding and categorization; (2) memoing; and (3) theming (36) .
Coding was initiated by re-reading the transcripts to become more familiar with the data and to obtain a sense of the whole. Subsequently, key words and phrases were highlighted line-by-line with analytic notes recorded in the margins. Then, when important words and phrases were identified and labeled, codes were created based on words and ideas within the data (also known as open coding). At first, codes were broad and generic to help us make sense of the data, and more abstract codes were developed as the analysis progressed. With each new concept that appeared, previous data were reviewed to add additional codes where appropriate.
As the coding process continued, categories were created, linking together the relationships between codes and ideas within the data. To assist in the development of categorization, the data were reorganized by grouping together related codes rather than by chronological order. Using NVivo 11, a data matrix was generated to summarize the data and to compare and contrast the experiences of each participant. The final categories were the ones that re-occurred frequently in the interviews and/or were central concepts in answering the research questions. A summary was then written for each category, which was then reviewed for homogeneity.
Themes were built from relationships between the codes, categories, and the larger patterns woven throughout the data that made up the "cultural scene" (37) .
With an ongoing analysis of the interviews, developing themes were incorporated into follow-up interview questions. This helped us identify patterns among participants and consider or reject generated concepts.
During this entire process, analytic memos were formulated. They were free-style records of the ideas or insights the researcher had about the data. This strategy was used to assist the researcher in making conceptual leaps from raw data to those abstractions that explain research phenomena in the context in which they were examined. The analysis was initiated and led by the first author, and further analyzed and discussed among all authors until consensus was reached to increase reliability of the findings. The participants were assigned pseudonyms for de-identification.

Reliability
Rigor is characterized when the research methods are justified, the process is transparent, the outcomes are defendable, and the findings are viewed as applicable by research consumers. For this study, we borrowed Tracy's (38) criteria for operationalizing reliability of qualitative data.
Throughout the article we showed that this study (1) is about a worthy topic that is relevant, timely, significant and interesting, as well as it makes a unique contribution to the health field; (2) has resonance by means of transferability, which is the potential of the study to be relevant in other contexts and with other populations; (3) makes a significant contribution by generating further debate and inspiring future research, and (4) possesses ethical integrity, which was attempted by addressing Rev. Latino-Am. Enfermagem 2023;31:e3813.
ethical requirements and avoiding deductive disclosure, i.e., identification of an individual's identity using known characteristics of that person.
In addition, to achieve sincerity, the first author wrote a reflexive journal, where she logged the details of how her assumptions and personal reactions may have influenced the results of each interview and observation, her agenda as a researcher, her assumptions as an individual, her research process, the intersubjectivity of the findings, and self-interrogations. In addition, the first author kept an audit trail to track her choices, hunches and interpretations. Equally important for credibility, accuracy of representation was attempted through crystallization of meanings between the authors. According to Tracy (38) , "the goal [of crystallization] is not to provide researchers with a more valid singular truth, but to open up a more complex, in-depth, but still thoroughly partial, understanding of the issue".

Results
The list of potential participants who consented to be approached included 51 individuals. When data generation was initiated, five of the 51 potential participants had passed away, four refused to participate, three had moved, sixteen were not eligible to participate by the time we approached them due to health conditions, and three refused to participate stating inability due to physical decline. In the end, 20 participants finished the 4-week Sit-to-stand activity.  She wondered about which aspects of the activity were of interest to the participants at the outset as she tried to understand their motivation and reasons to join, or not, the Sit-to-stand activity. The subthemes related to the participants' first impressions of the Sit-to-stand activity were as follows: "structural aspects" and "individual influence". The categories linked to the "structural aspects" subtheme were the following: "having a flexible schedule", "trying something new", "changing the routine", and "having someone to do it with". The categories linked to the "individual influence" subtheme were "having physical limitations", "stigmatization associated with exercises targeting older people", "establishing intentions" and "having goals". was also an opportunity for the researcher to take her hunches and ideas back to the participants so they could discuss and negotiate meanings. The subthemes related to their completion of the 4-week activity were "drivers" and "obstacles". The categories linked to the "drivers" subtheme were as follows: "cost", "privacy", "perceived benefits in mental and physical health", "going at own pace and adapting the activities", "sense of achievement", "having a supportive system" and "easily integrated into the daily routine". The categories linked to the "obstacles" subtheme were the following: "present health condition", "no perceived need", "fatalism", "fear of worse outcome", "lack of companion", "lack of motivation", "competing demands", "routine challenge/discipline", "safety concern" and "weather". Each one of the themes, as well as their respective subthemes and categories, are described in   This section presents the analysis of the data from the participant observations and interviews. Two themes were constructed during the analysis. The first theme, "to join, or not to join: that is the question", started to be

Structural aspects
The structural aspects were related to the elements of the Sit-to-stand activity. The participants usually considered the proposed activity offered to them because they were allowed flexibility to schedule it according to their pre-established routine. Another factor for those who expressed interest in pursuing the activity was the excitement of engaging in something new. Usually, these participants were retired and their lives had a slower pace than before. Sonata, for instance, portrayed it quite well.
She spent her days by herself. She worked her entire life outside her home but, after she retired, her life changed.
While she lived with her daughter, her child went out early in the morning and came back home late in the evening.
According to her, she could benefit from some changes here and there.
On the other hand, a few participants hesitated to join the activity due to the changes it could impose on their previously established routine. The pre-established daily rituals were meaningful to participants and suggesting a change in the routine was a source of discomfort for some participants. Another pertinent concern raised by some participants was their fear of doing the activity by themselves. Overall, those who were alone during the day had a poor perception of their health or belonged to the oldest old age group and stated that having someone to do the activity with was an important element.

Individual influence
Factors within individuals affecting their perceptions of the Sit-to-stand activity, including ways of thinking, feeling, and acting when they were invited to do the Sit-to-stand activity are described here. When the participants perceived themselves as having physical limitations, they were more resistant to engage in the Sit-to-stand activity. However, it was not only the participants' physical limitations and health conditions that permeated their assumptions about the Sitto-stand activity, but also the perceived stigmatization of exercises targeting older people.
Referrals from healthcare providers also influenced the participants' intention to perform the Sit-to-stand activity. When healthcare providers from the Family Health Strategy had previously talked to them about performing some physical activity or the benefits of the Sit-to-stand activity, they were more inclined to join it. Furthermore, the participants' families also played an important role in their intention to perform the Sit-to-stand activity.
In addition, when the participants had goals, they agreed to participate in the activity more promptly. For instance, Juliette was housebound and her daughter and son-in-law assisted her with some activities of daily living.
After she started doing the Sit-to-stand activity, she stated feeling less pain in her legs. Although the goal of the activity proposed is not to reduce pain but to strengthen muscles and assist with balance, her own perceptions and goals exerted a positive effect on her engagement in the Sit-to-stand activity.  Wisnesky UD, Olson J, Paul P, Dahlke S.

How did it go?
During the weekly follow-up visits, the participants and the researcher talked about the Sit-to-stand activity, their progress and their impressions of it. They also discussed whether there were any unexpected events from the previous week.

Drivers
The participants highlighted various elements of the Sit-to-stand activity that sustained their participation.
Its low cost, translated into no gym membership fees and no specialized equipment or travel costs required; these factors were perceived as advantageous for the participants. Another positive component of the Sitto-stand activity was the possibility of doing it in the participants' own home, which offered them some privacy to perform the activity without feeling judged or observed.
In addition, the participants emphasized how the activity made them feel. When they could envision or feel an improvement in their mental or physical health, they seemed more willing to keep performing the Sit-to-stand activity. The easiness of the activity and the participants' ability to adapt the activity to their reality, coupled with the opportunity of performing the Sit-to-stand activity at their own pace, also exerted a positive influence on adherence to the activity. Another important element was the participants' sense of achievement. When they felt that they crossed self-imposed milestones, they were more confident about the future.
Having a supportive system also influenced the participants' engagement in the activity. In most instances, they lived with family members and these relatives were quite supportive of their engagement in the Sit-to-stand activity. The family members would assist the participants when they needed help to accomplish the activity. They would encourage and remind them of the activity. Support from the participants' social circles was also an important ingredient in their positive experience of the activity. However, the influence of supportive networks extended beyond the participants' friends and family.
A supportive healthcare system also determined their positive experience with the Sit-to-stand activity. When the participants felt that they were well cared for by the health professionals and well served by the healthcare system, they were more prone to engage in the Sit-tostand activity. Finally, the participants also had an easier time when they were able to fit the activity into their daily routine.

Obstacles
The participants highlighted various elements of the Sit-to-stand activity that hindered their participation. Many of them related the impact of their present health conditions and their symptoms such as lack of balance, lack of strength, fatigue and pain as factors hindering their ability to do the Sit-to-stand activity. At times, they did not perceive a need to perform the activity. The participants who were not able to visualize the benefits of the activity engaged in it less frequently. In addition, those who believed that, regardless of their actions or deeds, there are some things in life that are predestined to occur, had more difficulties engaging in the activity. This sort of fatalism was illustrated by some participants while doing the Sit-to-stand activity.
Likewise, when the participants were fearful of reaching a worse outcome, they had more difficulties when engaging in the activity.
Another recurrent complaint was lack of companion to do the activity. Most of participants lived with or close to their family members but a few of them spent the day by themselves due to their family members' work schedules during the day or their significant other not being present.
For instance, in one of our informal interviews, Acacia conveyed that her late husband was her companion for travel and in physical activities but that, since his passing away, she had lost the person who used to do activities with her.
Some participants mentioned that lack of motivation, safety concerns, weather and competing demands in their lives precluded them from trying to perform the activity. The issues varied from family problems to health concerns. Yet, one of the most cited reasons hindering the participants' engagement in the activity was their inability to insert the activity into their routine.

Discussion
The key findings from this study are that the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants seemed to find the activity enjoyable;

Establishing intentions
Before engaging in the Sit-to-stand activity, the participants referred to perceived barriers and benefits Sit-to-stand activity potential areas for refinement in the knowledge translation process.
A few participants stated having or suffering negative stigmatization of growing old and exercising. There is mounting evidence to suggest that older people constitute a stigmatized group around the world (39) . In fact, "ageism" reveals the stigma and negative attitudes associated with advanced age that are linked to mental and physical health consequences, including less desire to live a healthy lifestyle (40)(41) . This is corroborated by the literature on the stereotype threat, suggesting that stigmatized individuals avoid the negative experience of such threat by disengaging from important activities (42) . The issue of ageism is so rampant that the UN Decade of Healthy Ageing presents an agenda with calls to action, where the first action is to change how people think, feel and act toward age and ageing (13) . It is argued that reducing ageism is important given its widespread impact on the Triandis (45) attitude-behavior theory, and the protection motivation theory (46) . These theories concur with the proposal that the most immediate and important predictor of a person's behavior is his/her intention to perform it and having goals.

The experience with the components of the activity
Identifying the structural elements of a future intervention is a crucial part of unpacking the "intervention black box". Knowledge of individuals' perceptions of structural elements can be used to identify specific practices that promote adoption and optimize interventions.
During and after engaging in the Sit-to-stand activity, the participants of this study reported the low cost for this activity for being home-based, the possibility to do it at their own pace, and its ease of integration into a daily routine as components of the activity that supported its adoption. However, it is also important to consider other components of the activity that undermined its adoption, such as safety concerns and lack of a companion.
The results of this study indicate that there were a range of factors that contributed to the participants' engagement in the Sit-to-stand activity. The activity's low-cost was attributed to non-requirement of specialized equipment and travel, which, in turn, is connected to the activity's accessibility. This result was built on a metasynthesis of qualitative studies of independently living older people's (+65 years old) experiences of physical activity interventions in non-clinical contexts and found that keeping costs to a minimum was important, as many aged individuals earn limited incomes (47) .
In this study, some of the participants described the home-based scope of the Sit-to-stand activity as meeting their needs, particularly because it allowed them to enjoy their privacy while performing the activity. This result is in line with previous researchers who also found that doing exercises at their home allowed the participants the privacy to perform them without feeling judged or observed (48) .
On the other hand, a few participants felt that the homebased scope of the activity was disadvantageous because it removed from them the opportunity of social integration.
However, it has been suggested that, while group-based programs are more effective in the short term, home-based programs appear to be more effective when it comes to physical activity maintenance in older individuals (49) .
For these participants, the possibility of doing the Sit-to-stand activity at their own pace, its adaptability, and its ease of integration into their daily routine worked as facilitators. This result is also consistent with previous research findings pointing out that "older adults should be encouraged to go at their own pace, although they should also be supported to increase intensity or duration when they are able to do more (47) . This is important, as they may have self-limiting expectations that have to be addressed but that need to be handled sensitively". In addition, the ability to integrate the Sit-to-stand activity into participants' daily routine was previously mentioned in other studies as a driver to engagement in the activity (indicating that a collaborative and mindful approach to physical activity seems more acceptable to older people) (50) .

The personal experience with the activity
Perceived health benefits, having goals, being motivated, and having a sense of achievement were individual factors facilitating the Sit-to-stand activity.
Conversely, the impact of comorbidities, fatalism, no perceived need, fear of worse outcomes, and lack of Wisnesky UD, Olson J, Paul P, Dahlke S. motivation were individual factors hindering the activity.
A key facilitator for performing the Sit-to-stand activity was the participants' observations of personal benefits because of the activity. That was possible when they set small achievable goals, which, in turn, motivated and gave them a sense of achievement. The role of experiencing some personal benefit as a result of the activity was previously discussed in studies with older people (51)(52) .
The authors found that higher perceived health benefits and greater self-efficacy were associated with physical activity among older people. Thus, the potential benefits of engaging in a lifestyle that incorporates regular physical activity are to improve physical function, independence and quality of life (52) . These changes have been shown to be beneficial even when physical activity is started at a later stage in life (52) .
In a reverse situation, the participants' comorbidities, fears of worse outcomes, lack of motivation, fatalistic views and no perceived need were key barriers to performing the Sit-to-stand activity. Although having comorbidities was probably the most often mentioned barrier to engaging in the Sit-to-stand activity among the participants, perceived health benefits from engaging in the activity were the most often reported motivators for the activity. This finding is consistent with the literature, where it is revealed that perceived health benefits represent a factor that can work in both directions (41) .
They can be viewed as a facilitator motivating physical activity or as a barrier detracting from physical activity when no benefit is anticipated.
In addition, when these study participants had set goals for themselves, it fostered their participation in the Sit-tostand activity. Goals are defined as internal representations of desired outcomes, events or processes. Goal setting is one of the most widely applied and universally accepted strategies used to increase physical activity (53) .
Over time, satisfactory feelings such as motivation and achievement appeared to exert a positive influence on the participants' engagement in the Sit-to-stand activity.
Other researchers have shown that similar remarks predict higher levels of adherence to physical activity and exercise (47,(54)(55)(56) . In addition, the individual's motivation is a key factor influencing mobilization, especially if they are able to safely walk by themselves or with family members (56) .

The interpersonal experience with the activity
The participants included in this study described having a supportive system and a companion, and not having competing demands as interpersonal factors influencing their experience with the Sit-to-stand activity. Family and friends played a role in encouraging participation in, and adherence to, the Sit-to-stand activity. Both the importance of concrete support, such as being able to push and help the participants, as well as emotional support was emphasized. Others researchers have shown that support from family, friends, peers and caregivers is considered critical to promoting and maintaining engagement with any exercise/activity intervention (48,57) . The participants' choice in accepting engagement in a physical activity is framed by the physiological and psychological impacts of the intervention and also by the social and cultural structures in which a person is living (58) . Thus, social and cultural factors appear to shape expectations of engagement in the Sit-to-stand activity.
The meaning of social networks was also shown by in decreased adherence and dropout from physical activities (59) . It is noteworthy that, in numerous studies, a common barrier reported by underprivileged groups of older people was competing family responsibilities (59) .
This study is the first one of its kind to capture Functional mobility is vital for activity and participation and reduces dependence. Specifically in the Global South, older people with significant mobility challenges are at risk for additional mobility-related poor health outcomes (11)(12) . Nurses are in a prime position to facilitate changes in practice and education that could reduce disability, improve mobility and increase trust between patients and healthcare providers. Findings from this study may be used to improve older people's health, as they provide important clues about how to  (60) . In addition, due to limited time and resources, the perceptions and experiences of healthcare providers, family members and policy makers were not examined.

Further research is necessary into other stakeholders'
perceptions of the Sit-to-stand activity, and whether there are shared perceptions.

Conclusion
This study provides new information to the field of inquiry on mobility of older people because it focuses on the perceptions of a specific age group, and attends